| NPI | 1972367076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ELIZABETH JACSKSON Director 502-330-8522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-06-11 |